DEAR Adult: One Path to Interpersonal Effectiveness (Part 9 of 10)

Whereas all the other skills mentioned so far are about self-regulation, interpersonal effectiveness inherently involves both the self and someone else. Therefore, interpersonal effectiveness inherently subsumes the other skill sets. After all, you can’t possibly deal with another person if you can’t even deal with yourself yet. 

Here, I would like to introduce perhaps the most comprehensive of the interpersonal effectiveness skills: DEAR Adult. D stands for Describe: First, describe the situation that needs to be addressed. State only the facts, and truly focus on the situation, not the person. Next, Express how you feel about the situation. Use “I feel” statements. Once again, truly express how you feel about the situation, not the person. Sometimes it can be helpful to use a “float back” and express how you have felt about similar situations previously so that both you and the other person understand that there might be more history beyond the current situation. If you want to be especially dialectical, also use this E to Empathize with the other person’s perspective.

Now you are ready to move on to A, which stands for Assert. When asserting, use “I need” statements. In particular, explain what you need in positive terms, not negative ones; explain precisely what you need the other person to do, not what they should stop doing. If you want to be even more dialectical, also use the A to Appreciate the other person’s perspective and even Apologize for your role in this situation.

R stands for Reinforce. You want to end on a positive, upbeat note by reinforcing both your request and the relationship itself. In my opinion, the best way to reinforce both is to explain how what you are requesting is a win-win proposition. You simply want what is best for both parties. Therefore, you are willing to further negotiate and compromise as necessary.

Finally, you want to do all of this using the Adult Voice, which is the dialectic (the middle ground) between the Parent Voice (yell, lecture, berate) and the Child Voice (whine, pout, throw a tantrum). The Adult Voice is when you communicate in a manner that is calm, composed and collected.

This blog post is an excerpt from Trauma stabilization through polyvagal theory and DBT, an article published by the American Counseling Association on September 14, 2021 by Kirby Reutter.

 If you would like to learn more about how to use trauma-focused DBT with a variety of trauma-based disorders, I recommend the following resources to get started:

• The Dialectical Behavior Therapy Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder by Kirby Reutter, 2019
• “DBT for Trauma and PTSD” (DBT Expert Interview series at psychotherapyacademy.org/dbt-interviews)
• Survival Packet: Treatment Guide for Individual, Group, and Family Counseling by Kirby Reutter, 2019
• “The Journey From Mars: Brain Development and Trauma” webinar (youtube.com/watch?v=WSFqHS_axOc)

Working the TOM: One Path to Dialectical Thinking (Part 8 of 10)

Dialectical thinking is all about letting go of the extremes, learning to think more in the middle, learning to be more flexible with your cognitions, learning to see things from someone else’s perspective, learning to see things from multiple perspectives in your own head, and learning to update your beliefs when presented with new information.

When I teach dialectical thinking to clients, I use a very simple process: We work the TOM, which stands for Thought, Opposite and Middle. First, we identify the original problematic thought. Next, we identify the complete opposite extreme of that cognition. Finally, we brainstorm a possible belief somewhere more in the middle.

Let’s assume a client has the original problematic thought of “I am not good at anything.” The complete opposite extreme would be: “I have never once made a mistake. I am absolutely flawless. I am the most competent human specimen that has ever existed.” And something more in the middle might be: “There are some things I am OK at, but there are also lots of things that I need to work on.”

The purpose of this exercise is to help clients quickly identify a cognition that is most likely much more accurate than the original belief. Clients may not always be able to come up with a middle thought on their own, so it is completely fine to help them at first. Eventually, however, it is better if clients can generate their own middle thoughts because whatever they produce will inherently be more believable than whatever you come up with. Even if the client insists they do not believe the middle thought that they generated, chances are that part of them does — because those words came from their mind. Regardless, your job is not to try to convince your client that the middle thought is more accurate; it is simply to plant the seed for that thought and then let it germinate on its own.

In fact, the more the client wrestles with the middle thought, the more they are thinking about it, therefore reinforcing the new cognition.

This blog post is an excerpt from Trauma stabilization through polyvagal theory and DBT, an article published by the American Counseling Association on September 14, 2021 by Kirby Reutter.

 If you would like to learn more about how to use trauma-focused DBT with a variety of trauma-based disorders, I recommend the following resources to get started:

• The Dialectical Behavior Therapy Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder by Kirby Reutter, 2019
• “DBT for Trauma and PTSD” (DBT Expert Interview series at psychotherapyacademy.org/dbt-interviews)
• Survival Packet: Treatment Guide for Individual, Group, and Family Counseling by Kirby Reutter, 2019
• “The Journey From Mars: Brain Development and Trauma” webinar (youtube.com/watch?v=WSFqHS_axOc)

Sow Your SEEDS: One Path to Emotion Regulation (Part 7 of 10)

Whereas distress tolerance refers to short-term coping in the moment, emotion regulation refers to a long-term lifestyle change that will ultimately support much healthier emotionality. When I teach emotion regulation skills to clients, I use an extended garden analogy. For example, if you want to have a healthy garden of flowers, would it make any sense to scream and swear at the flowers? Ignore the flowers? Shame the flowers? Coerce or manipulate the flowers? Of course not. Your flowers do not need to be controlled — they need to be cultivated. 

The same concept applies to our emotions. Instead of trying to control them, we need to care for them — like beautiful, delicate flowers. (By the way, it makes me cringe every time that I hear therapists — and even DBT practitioners, no less — paraphrase emotion regulation as “controlling your emotions.”) There are several things you need to do to care for a real garden: plant the right seeds, do some weeding, check the soil, continue to care for the garden even when you feel like giving up, and fertilize. Each of these activities represents a specific way to care for our emotions as well. Here, I will simply introduce the first one: You need to plant the right SEEDS.

Planting the right SEEDS refers to five ways of taking care of your physical body: Symptoms, Eating, Exercise, Drugs and Sleep. If you want to have a healthy garden of emotions, you will need to plant each of these seeds by addressing physical symptoms, finding healthy eating patterns, getting moderate exercise, monitoring which drugs enter your body, and getting adequate sleep. After helping my clients develop a specific plan for each of these “seeds,” I often have them provide me with a quick SEEDS report at the beginning of each session, as part of their weekly check-in. 

This blog post is an excerpt from Trauma stabilization through polyvagal theory and DBT, an article published by the American Counseling Association on September 14, 2021 by Kirby Reutter.

 If you would like to learn more about how to use trauma-focused DBT with a variety of trauma-based disorders, I recommend the following resources to get started:

• The Dialectical Behavior Therapy Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder by Kirby Reutter, 2019
• “DBT for Trauma and PTSD” (DBT Expert Interview series at psychotherapyacademy.org/dbt-interviews)
• Survival Packet: Treatment Guide for Individual, Group, and Family Counseling by Kirby Reutter, 2019
• “The Journey From Mars: Brain Development and Trauma” webinar (youtube.com/watch?v=WSFqHS_axOc)

TIP the Balance: One Path to Distress Tolerance (Part 6 of 10)

DBT distress tolerance is all about learning to cope in the moment without making it worse. It is about replacing impulsive, addictive, risky or self-injurious behaviors (in other words, any behavior that leads to even more of a crisis orientation) with more-effective coping strategies.

One of my favorite distress tolerance skills has to do with finding ways to TIP the balance. Because there is such a direct and obvious mind-body connection, often the quickest way to shift your mood is to quickly shift something in your body. If you can “tip” your body chemistry, you can also “tip” the balance on your emotions. There are three ways to quickly TIP your body chemistry: Temperature, Intense exercise and Paced breathing/Paired muscle relaxation (this refers to tensing your muscles as you inhale and relaxing your muscles as you exhale). 

Although each of these techniques is effective on its own, they can be even more effective when done together. For example, one way I personally TIP the balance in my own life is by riding my bicycle. This activity helps me to quickly change my body temperature, involves intense physical exercise, and helps me synchronize my respiration (inhale/exhale) with my musculation (tense/relax) through the cyclical nature of pedaling.

This blog post is an excerpt from Trauma stabilization through polyvagal theory and DBT, an article published by the American Counseling Association on September 14, 2021 by Kirby Reutter.

 If you would like to learn more about how to use trauma-focused DBT with a variety of trauma-based disorders, I recommend the following resources to get started:

• The Dialectical Behavior Therapy Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder by Kirby Reutter, 2019
• “DBT for Trauma and PTSD” (DBT Expert Interview series at psychotherapyacademy.org/dbt-interviews)
• Survival Packet: Treatment Guide for Individual, Group, and Family Counseling by Kirby Reutter, 2019
• “The Journey From Mars: Brain Development and Trauma” webinar (youtube.com/watch?v=WSFqHS_axOc)

The RAIN Dance: One Path to Mindfulness (Part 5 of 10)

Mindfulness, by definition, is always a combination of both awareness and acceptance. The RAIN dance helps clients increase both awareness and acceptance of intense emotions and other triggers in a highly practical and applied manner. RAIN stands for Recognize, Allow, Inquire and Nurture.

The purpose of this acronym is to help clients know precisely how to apply mindfulness in a real-life situation. Let’s suppose you want to help a client become more mindful of their anger. First, teach your client to recognize their anger — and especially where they notice it in their bodies (e.g., clenched jaw). Next, teach your client to allow their anger (instead of judging or resisting it, which will make it only more difficult to manage in the long run.). Then, teach your client to inquire about their anger — with curiosity, empathy and maybe even humor. (Fear and anger are neurologically incompatible with empathy, curiosity, and humor.) Finally, teach your client to engage in some sort of nurturing (i.e., self-soothing) behavior to release the anger in an appropriate manner (such as taking a long walk through the woods). The emotional energy will need to become appropriately discharged, especially if the intense emotion has resulted from a fight-or-flight response; otherwise, this energy will simply become frozen — and then continue to resurface when triggered. 

The basic idea behind this skill is simple: Learn to “dance” with your emotions rather than avoiding, resisting, suppressing or judging them.

This blog post is an excerpt from Trauma stabilization through polyvagal theory and DBT, an article published by the American Counseling Association on September 14, 2021 by Kirby Reutter.

 If you would like to learn more about how to use trauma-focused DBT with a variety of trauma-based disorders, I recommend the following resources to get started:

• The Dialectical Behavior Therapy Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder by Kirby Reutter, 2019
• “DBT for Trauma and PTSD” (DBT Expert Interview series at psychotherapyacademy.org/dbt-interviews)
• Survival Packet: Treatment Guide for Individual, Group, and Family Counseling by Kirby Reutter, 2019
• “The Journey From Mars: Brain Development and Trauma” webinar (youtube.com/watch?v=WSFqHS_axOc)

Restoring Balance (Part 4 of 10)

Dialectical behavior therapy (DBT), which was developed by Marsha Linehan, is all about reconciling “dialectical dilemmas” (binary extremes resulting in dysfunction) by teaching specific behavioral skills to forge a “middle path” between those extremes. In particular, DBT teaches the following five skill sets: mindfulness, distress tolerance, emotion regulation, dialectical thinking and interpersonal effectiveness. These skill sets teach the middle path between each of the dialectical dilemmas mentioned in the previous section.

As long as clients are existing and operating at these extremes, it is extremely difficult for them to do even basic counseling — much less trauma work and much less life. That is why DBT as a treatment model is entirely skills focused. DBT teaches the foundational skills one needs to optimize counseling, stabilize for trauma work and then thrive in life — “building a life worth living,” in the words of Linehan. Among dozens of skills that could be highlighted, I would like to present five simple acronyms to help clients find — or forge — each of these middle paths.

This blog post is an excerpt from Trauma stabilization through polyvagal theory and DBT, an article published by the American Counseling Association on September 14, 2021 by Kirby Reutter.

 If you would like to learn more about how to use trauma-focused DBT with a variety of trauma-based disorders, I recommend the following resources to get started:

• The Dialectical Behavior Therapy Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder by Kirby Reutter, 2019
• “DBT for Trauma and PTSD” (DBT Expert Interview series at psychotherapyacademy.org/dbt-interviews)
• Survival Packet: Treatment Guide for Individual, Group, and Family Counseling by Kirby Reutter, 2019
• “The Journey From Mars: Brain Development and Trauma” webinar (youtube.com/watch?v=WSFqHS_axOc)

A Breakdown in Dialectics (Part 3 of 10)

This driving metaphor describes what happens to people who have experienced chronic trauma: too much accelerating, too much braking, and loss of social engagement to boot. This leads to a vast variety of responses that are either “too much” or “too little,” resulting in a host of life complications. This tendency toward too much or too little especially affects the following domains:

• Awareness
• Thoughts 
• Emotions 
• Reactions 
• Relationships 

For each of these domains, it is possible to have either too much (overuse of the accelerator, or sympathetic nervous system) or too little (overuse of the brake, or parasympathetic nervous system). Too much awareness leads to hypervigilance, whereas too little leads to dissociation. Too much thinking leads to obsessive rumination, whereas too little leads to impulsive decision-making. Too much emotional stimulation leads to overwhelm, whereas too little leads to numbness. Too much reactivity leads to even more crises, whereas too little leads to paralysis. Even relationships can be either too much or too little, resulting in either overdependence or under-dependence on others.

In short, trauma results in all of the following possibilities: over-awareness versus under-awareness; overthinking versus under-thinking; overemoting versus under-emoting; overreacting versus underreacting; and over-relating versus under-relating. Because both the sympathetic and parasympathetic nervous systems have been hijacked, the driver is constantly over-accelerating and over-braking in each of these domains — and often doing both at the same time.

This blog post is an excerpt from Trauma stabilization through polyvagal theory and DBT, an article published by the American Counseling Association on September 14, 2021 by Kirby Reutter.

 If you would like to learn more about how to use trauma-focused DBT with a variety of trauma-based disorders, I recommend the following resources to get started:

• The Dialectical Behavior Therapy Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder by Kirby Reutter, 2019
• “DBT for Trauma and PTSD” (DBT Expert Interview series at psychotherapyacademy.org/dbt-interviews)
• Survival Packet: Treatment Guide for Individual, Group, and Family Counseling by Kirby Reutter, 2019
• “The Journey From Mars: Brain Development and Trauma” webinar (youtube.com/watch?v=WSFqHS_axOc)

The Two Pedals (Part 2 of 10)

Think of the sympathetic nervous system as the accelerator and the parasympathetic nervous system as the brakes. As we drive down the highway, we need both of these functions. If the drive is smooth, sometimes we will gently accelerate and sometimes we will gently brake. The same process applies to our physical, mental and emotional functioning. If the “drive” is smooth, our mind and body enjoys a gentle oscillation between accelerating and braking. 

This is even reflected in our heart rhythm. A healthy rhythm is indicated by a consistent repetition of fast/slow, fast/slow, fast/slow. The reason for this gentle pendulation is so that the entire organism, at a moment’s notice, can either further accelerate or further break, as needed. A heartbeat that is either consistently fast or consistently slow or irregularly fast/slow is not a healthy rhythm because these circulation styles cannot allow for the gentle oscillation between accelerating and braking that is required for a smooth ride.

Let’s return to our driving analogy. If you are driving down the highway and a truck carelessly swerves right in front of you, you will probably have all of the reactions represented by the polyvagal theory: You may swear and flash various fingers (social engagement goes offline), you may suddenly accelerate, or you may slam on the breaks. But after the danger is averted, you will most likely return to your baseline of gently oscillating between accelerating/braking as needed — until the next threat again requires more extreme action.

Now let’s assume you have experienced so many roadside perils that you decide never to let down your guard. You are poised at every moment to yell and scream at other drivers, unpredictably accelerate and unpredictably brake. If you are really frazzled, you may even attempt to accelerate and brake simultaneously. Over time, this becomes your new default driving style, regardless of the driving conditions: cuss everyone out, suddenly accelerate, suddenly brake. (You may have noticed that in some major cities, this sort of driving is common.) Do you see how this will lead to a wild ride? Even if the driving conditions would otherwise have been relatively smooth, they won’t be anymore. And even if no danger would otherwise have been present, now there is. You are off to the races …

This blog post is an excerpt from Trauma stabilization through polyvagal theory and DBT, an article published by the American Counseling Association on September 14, 2021 by Kirby Reutter.

If you would like to learn more about how to use trauma-focused DBT with a variety of trauma-based disorders, I recommend the following resources to get started:

• The Dialectical Behavior Therapy Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder by Kirby Reutter, 2019
• “DBT for Trauma and PTSD” (DBT Expert Interview series at psychotherapyacademy.org/dbt-interviews)
• Survival Packet: Treatment Guide for Individual, Group, and Family Counseling by Kirby Reutter, 2019
• “The Journey From Mars: Brain Development and Trauma” webinar (youtube.com/watch?v=WSFqHS_axOc)

Trauma stabilization through polyvagal theory and DBT

From article published by the American Counseling Association on September 14, 2021

By Kirby Reutter

Introduction (Part 1 of 10)

From my perspective, polyvagal theory has thus far provided us with the best working model of how trauma affects the brain and the body. According to this model, trauma has an impact on both branches of the autonomic nervous system (sympathetic and parasympathetic), which includes both branches of the parasympathetic nervous system (ventral and dorsal). 

The sympathetic branch of the nervous system is associated with physical and emotional acceleration (such as increased fear, anger, breathing and heart rate); in the case of danger, this means “fight or flight.” In contrast, the parasympathetic branch of the nervous system is associated with physical and emotional deceleration. More specifically, the ventral branch of the parasympathetic nervous system is associated with social engagement, while the dorsal branch is responsible for “rest and digest” functions and, in the case of extreme threat, “freeze.” Freeze occurs when the organism either mentally dissociates or, in even more extreme cases, faints.

When presented with danger, the various branches of the autonomic nervous system are affected in a specific order. The first branch to be affected is the ventral sub-branch of the parasympathetic nervous system, which is responsible for social engagement. In other words, when presented with threat, functions related to social connectivity — laughter, smiling, empathy, attunement, the ability to provide validation — go offline. If the danger persists, the next branch to be affected is the sympathetic nervous system, which results in fight or flight. When neither fight nor flight can mitigate the threat, the dorsal sub-branch of the parasympathetic nervous system is activated, resulting in freeze (some sort of either mental or physical collapse, such as dissociating or fainting). The following actions summarize this sequence:

1. Danger is sensed.
2. Social engagement goes offline (ventral parasympathetic nervous system).
3. Danger persists.
4. Fight or flight is triggered (sympathetic nervous system).
5. Danger cannot be mitigated through fight or flight.
6. Freeze response activates (dorsal parasympathetic nervous system). 

If you would like to learn more about how to use trauma-focused DBT with a variety of trauma-based disorders, I recommend the following resources to get started:

• The Dialectical Behavior Therapy Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder by Kirby Reutter, 2019
• “DBT for Trauma and PTSD” (DBT Expert Interview series at psychotherapyacademy.org/dbt-interviews)
• Survival Packet: Treatment Guide for Individual, Group, and Family Counseling by Kirby Reutter, 2019
• “The Journey From Mars: Brain Development and Trauma” webinar (youtube.com/watch?v=WSFqHS_axOc)

In the blog post on Restoring Balance with Relationships, do you remember how we learned the DEAR Adult tool to assert, appreciate, and apologize? In this post, you are going to learn a similar tool to continue your healing journey: DEAR Self. In particular, you will be writing a series of letters to your traumatized Self.

Please note: The following exercises should only be completed (1) if you are currently receiving support from a professional counselor, and (2) if you have already worked your way through the rest of the workbook.

Think of one of your traumatic experiences. If this is your first time doing this, do not select the worst trauma that ever happened to you. Instead, chose one to practice with that is not so triggering that it will cause you to relapse in your treatment. The format you will be using to write this letter is DEAR Self.

1. Describe

Recall that the first part of this sequence stands for describe. In the first part of your DEAR Self letter, you will describe a traumatic event that happened to you. You will describe the specific order of events. You will also describe what you experienced with each of your five senses (as many as apply): What you saw, what you heard, what you smelled, what you tasted, and what you felt.

2. Express / Empathize

Remember that the second part of this sequence stands for either express or empathize. Both apply in the DEAR Self letter. Express all the emotions that you felt when the trauma happened, as well as the emotions you experienced after the trauma ended. If necessary, identify the emotions that became frozen, numb, or stuck as a result of the trauma. Since you are writing this letter to the traumatized Self, provide the empathy that you never received at the time.

3. Assert - Appreciate - Apologize

Recall that the third part of this sequence stands for either assert, appreciate, or apologize. In your DEAR Self letter, you will be doing a little of each. First, you will assert to your traumatized Self that what happened was wrong and was not your fault, no matter what someone has told you. You may need to identify an ANT’s that you still believe about the trauma, and the dispute those ANT’s with balanced thinking. Second, you will verbalize appreciation to your traumatized Self for how strong and brave you were to have survived this trauma. Be sure to elaborate all of your positive qualities that allowed you to survive the trauma. Third, you will write the apology that you never received, or that you wish you could have received. You are not apologizing for your own trauma. Rather, you are apologizing that the trauma happened in the first place.

4. Reinforce

Remember that the fourth part of this sequence stands for reinforce. You may recall that reinforce means to either strengthen something or increase a behavior. In this case, you are going to strengthen your relationship to yourself as well as increase your dedication to the healing process. In other words, you are going to remind, reassure, recall, recommit. You will remind yourself that the trauma is now over. You will reassure yourself that you are now safe. You will recall all the skills you have learned along the way. And you will recommit to practicing these skills for as long as it takes. Another way to reinforce your healing journey is to find purpose in suffering. Ask yourself: How can my trauma be redeemed or repurposed for something positive? Or to help others? What insights about myself or life have I learned from this trauma that I could not have learned otherwise?   

5. Self

Do you recall from the chapter on relationships how important your delivery is? Well I can’t think of any other letter in which your delivery will be more important! Remember that you are writing each part of this letter to your traumatized Self. Therefore, remember to be kind, gentle, and compassionate, the same way you would write to your best friend. In addition, remember to use all of the skills you have learned so in this book. It is especially important to remember to be accepting and non-judgmental.

If at any point writing this letter becomes too triggering, stop this exercise and take care of yourself by using your skills!

The Diary Card is a great tool to help you remember your skills as well as a great tracking device to help you monitor your daily ups and downs. But what happens when you’re really stuck? What do you do when you find yourself in the same situation over and over again? Or when you keep making the same mistakes time and time again? What happens when you are stuck in a blind spot, and you can’t see your way out? Now it’s time for the Pattern Wheel!

An example of a Pattern Wheel is provided below. Feel free to take a sneak peek now. Here are the steps to follow:

1.    Identify a problem situation that keeps happening over and over again. This is called the prompting event.

2.    What is your interpretation of this situation? Identify any ANT’s which may be influencing your interpretation.

3.    What are your physical and/or emotional reactions to this situation?

4.    What are your problem urges? Remember, problem urges are what you feel like doing when triggered, not necessarily what you end up doing.

5.    Now identify your actual behaviors. What is your reaction to this situation?

6.    What are the consequences of your behaviors? How do these consequences make you vulnerable (set you up) for the same old prompting event to happen all over again?

7.    Once you have documented steps 1 through 6, go back to each step and identify at least one DBT skill that you have learned in this workbook that you can apply to stop this cycle from repeating itself.   

There are several things I want you to notice about this exercise. First, did you notice that the Pattern Wheel is designed to increase awareness, just like the Diary Card? While the Diary Card is designed to increase general daily awareness, the Pattern Wheel is designed in increase awareness of specific dysfunctional cycles that you get trapped in. In particular, the Pattern Wheel helps you identify each link in that cycle so that you can develop better insight into what specifically is keeping you stuck. Second, did you notice that you can break this cycle at any point? There are specific DBT skills that you can use at each link in this chain which will cause the chain to break. Even though it’s always best to break the cycle as soon as possible, it’s never too late. You can still break the cycle even when after the behavior has already occurred, and now you need to do repair work. And you can even break the cycle after you have already blown right past the prompting event all over again…for the 100^th time!

Let’s take a look at an example of the Pattern Wheel before you try this on your own. For the sake of argument, let’s just pretend that this is not a personal (recurring) example from my own marriage! 

1. Prompting Event:      

• My wife makes a suggestion, perhaps in the form of a critique.

Possible Skills:

• Mindfulness (Awareness + Acceptance)

2. Interpretation:

• “Nothing I ever do is ever good enough for her.”
• Possible ANT’s: over-generalizing, personalizing, mind-reading

Possible Skills:

• Work the TOM
• Play the DS

3. Emotional / Physical Reactions:

• I feel criticized.
• I feel humiliated.
• Breathing increases.
• Fists start to clench.

Possible Skills:

• Controlled breathing
• Muscle relaxation

4. Problem Urges:

• I feel like criticizing her back.

Possible Skills:

• Acting Opposite
• Letting Go

5. Actual Behavior:

• I say something negative to her.

Possible Skills:

• LUV Talk
• Get in my CAR

6. Consequences / Vulnerabilities:

• The negative comment I make about my wife confirms her original criticism. Because of how I handled this situation, I have directly contributed towards the same prompting event that started the whole sequence in the first place.

Possible DBT Intervention:

• DEAR Adult – Appreciate
• DEAR Adult – Assert
• DEAR Adult – Apologize

Enough about my own dysfunction. Now it’s your turn to practice!

Now that we have learned all of these great skills, we need a way to make sure we are applying them on a daily basis, starting with the very first skill we learned: mindfulness. The Diary Card is a simple chart which helps you become more mindful of your daily life, while also serving as a reminder to apply your skills. Remember our magic formula? Applied Mindfulness = Awareness + Acceptance + Action. Well, the Diary Card was designed to do all of that in one single chart! The chart is really easy to use. Simply complete this chart on a daily basis to track your thoughts, feelings, triggers, urges, behaviors, and skills applied. Don’t worry about remembering every single skill you have learned in this workbook: They are all included as reminders right on the chart! If you are in counseling with a professional therapist, you might want to bring in your Dairy Card to your sessions so that both you and your counselor can monitor your progress.

Diary Card

Possible Skills

• Coping Card
• Mindfulness
• Balanced Mind
• Functional Analysis
• Pattern Wheel
• Extreme Acceptance
• Smart Stubbornness
• Pros & Cons
• Half Smile
• Change the Temperature
• Exercise
• Controlled Breathing
• Muscle Relaxation
• Making Comparisons
• Counting Blessings
• Finding Humor
• Thought Stopping
• Memorization
• Helping Others
• Self-Care
• Looking Back
• Looking Forward
• One Thing at a Time!
• Mini Vacation
• Cheerleading
• Journaling
• Enjoyable Activities
• Soothing with the Senses
• Letting Go
• Urge Surfing
• Imagery
• Finding Purpose 
• TEA Party
• ANT Stomping